Postoperative Morbidity with Diversion after Low Anterior Resection in the Era of Neoadjuvant Therapy: A Single Institution Experience

Background: The use of defunctioning stomas has been advocated to mitigate the adverse sequela from anastomotic dehiscence after rectal cancer resection. The aim of this study was to report our experience with anastomotic dehiscence and overall morbidity of low anterior resections in the era of neoadjuvant therapy, where the use of fecal diversion is part of the standard operative strategy for low (< 5 cm) rectal anastomoses. Study Design: This retrospective case series included patients who were treated with neoadjuvant therapy and had rectal cancer resection with curative intent, from 1996 to 2007. Results: Two hundred thirty-seven patients (159 men, 78 women) with mean age of 59 years (SD ± 12.7 years), received 5-flurouracil-based infusional chemotherapy and external-beam radiation in the range of 45 to 54 Gy. Fifty-seven percent of patients underwent anterior resection and 43% had coloanal anastomosis. Anastomotic dehiscence occurred in 9 patients (3.8%). Seven of the anastomotic leaks were diagnosed as pelvic abscesses (2.1%) and 2 patients needed reexploration (0.8%). Early overall postoperative morbidity was 26%, and there was no postoperative mortality. One hundred ninety-one of 193 patients had their ileostomy reversed, with minimal morbidity (0.5% leak rate). Conclusions: Low postoperative morbidity after colorectal and coloanal anastomosis for adenocarcinoma is possible in patients who have received neoadjuvant therapy. Defunctioning stomas are safe and may mitigate the serious sequela of anastomotic dehiscence after low rectal anastomoses.